Director Of Claims

TEKsystems
$75.00 - $80.00 / hr
life insurance, sick time, 401(k), retirement plan
United States, California, Martinez
Jan 10, 2026
Description Our client, a large public health plan, has a need for a contract to hire Director of Claims. The group includes 20 direct reports including 2 managers, Claims supervisor, Claims Adjusters and Examiners. Much of the work includes support provider disputes, educationg providers and working through billing questions. The customer uses Epic Tapestry and you would have the opportunity to be trained on Epic. Top priorities when you start the job: a large backlog of pending claims which are in jeopardy of pending interest, performance improbement initiative and optimization of the department workflows for greater efficiency. Job Description: Contra Costa Health is offering an excellent opportunity for a Claims Director. The Claims Director plays a leadership role within CCGP, providing strategic and operational oversight of the claims function to ensure accurate, timely, and compliant payment of healthcare services. This position is responsible for setting direction, establishing controls, and guiding continuous improvement across claims operations while supporting positive provider relationships, regulatory compliance, and the financial integrity of the health plan. The Claims Director works closely with executive leadership and cross-functional partners to align claims operations, with accountability for claims adjudication, payment integrity, regulatory compliance, and vendor oversight across Medi-Cal, Medicare, and commercial lines of business. This role ensures claims operations support member access, provider relationships, and the financial integrity of the health plan. About them: They are a federally qualified, state-licensed, county-sponsored Health Maintenance Organization serving more than 250,000 residents. As part of the County's integrated public health system, plays a central role in delivering accessible, high-quality care to a diverse population. The primary business line is Medi-Cal, but also has a growing D-SNP product line as well as Commercial lines of business. We are looking for someone who is: Experienced in Managed Care Leadership: Brings extensive experience leading health plan claims operations within a managed care environment, including responsibility for complex, high-volume systems Knowledgeable in Medicaid and Medicare: Demonstrates deep understanding of Medi-Cal and Medicare program requirements, including claims payment policy, audits, and regulatory oversight A Strategic Thinker: Able to translate regulatory requirements and organizational priorities into sustainable operational strategies A Strong Communicator: Clearly conveys complex claims, financial, and compliance issues to executive leadership, staff, providers, and external partners Solution-Oriented: Proactively identifies operational risks and implements improvements that enhance accuracy, timeliness, and provider experience Professional and Collaborative: Builds strong working relationships across finance, compliance, IT, utilization management, and external vendors Discreet and Judicious: Exercises sound judgment in managing confidential, sensitive, and high-risk matters A People Leader: Invests in leadership development, succession planning, and workforce stability What you will typically be responsible for: Providing leadership and oversight of all CCHP claims operations, including claims adjudication, adjustments, payment integrity, and recovery activities Setting departmental strategy, goals, policies, and performance expectations aligned with CCHP's mission and regulatory obligations Directing, coaching, and evaluating managers and supervisors responsible for daily claims operations Overseeing third-party administrators, clearinghouses, and other claims-related vendors, including contract performance and issue resolution Directing the use and optimization of Epic Tapestry for claims adjudication, payment rules, edits, and reporting, and ensuring system changes are appropriately tested, documented, and implemented Implementing a claims editing software and establishing workflows to ensure payment integrity Ensuring full compliance with federal, state, and local regulations, including DHCS, DMHC, and CMS requirements Establishing and monitoring key performance indicators related to claims timeliness, accuracy, financial controls, and regulatory compliance Serving as the primary e liaison for claims-related matters with providers, county partners, auditors, and regulatory agencies Representing the orginzation at DHCS, CMS, and DMHC audits Identifying operational risks, audit findings, and systemic issues, and ensuring timely corrective action and reporting to executive leadership Collaborating with Provider Relations, Contracts, Finance, Compliance, Utilization Management, IT, and Quality divisions to support integrated operations and organizational objectives Leading initiatives related to system enhancements, policy updates, and process redesign to improve claims efficiency and transparency A few reasons you might love this job: You will shape the strategic direction of claims operations for a large, mission-driven public health plan You will have a direct impact on provider payment accuracy, regulatory compliance, and financial stewardship You will work with experienced, dedicated professionals committed to equity, accountability, and operational excellence You will play a key role in supporting healthcare access for the County's most vulnerable populations A few challenges you might face in this job: Navigating frequent changes in Medi-Cal, Medicare, and managed care claims regulations Balancing regulatory compliance, financial controls, and provider experience in a complex environment Managing system limitations, data dependencies, and cross-functional coordination Leading large-scale operational improvements while maintaining day-to-day performance Competencies Required: Delivering Results: Achieving organizational and regulatory goals through strong operational leadership and accountability Legal & Regulatory Navigation: Interpreting and applying complex laws, regulations, and guidance Ownership & Accountability: Taking responsibility for outcomes and ensuring follow-through across teams Handling Stress: Maintaining composure and sound judgment under pressure and competing priorities Oral Communication: Effectively communicating complex information to executive and external audiences Technology Leadership: Guiding the effective use of claims and payment systems to support operational performance, data integrity, and regulatory requirements, while partnering with IT on system enhancements and upgrades Minimum Qualifications Education: Possession of a Bachelor degree from an accredited college or university with a major in business administration, finance, accounting or a closely related field. Experience: Five (5) years of full-time or its equivalent experience as an administrator or manager in a health care organization, at least three (3) years of which must have been in either a patient financial services, patient business services, patient accounting, or insurance billing and collections. Substitution for Education Possession and maintenance of one of the following professional certifications: Certified Healthcare Financial Professional (CHFP) issued by the Healthcare Finance Management Association (HFMA) or Certified Patient Account Manager (CPAM) or Certified Clinic Account Manager (CCAM) certifications issued by the American Association Of Healthcare Administrative Management (AAHAM); or Certified Patient Account Technician (CPAT) or Certified Clinic Account Technician (CCAT) combined with additional four (4) years of qualifying experience can be substituted for the required education. Skills claims processing, claims mangement Top Skills Details claims processing,claims mangement Additional Skills & Qualifications Must work 4 days onsite/ 1 day remote Experience Level Intermediate Level Job Type & LocationThis is a Contract to Hire position based out of Martinez, CA. Pay and BenefitsThe pay range for this position is $75.00 - $80.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) Workplace TypeThis is a hybrid position in Martinez,CA. Application DeadlineThis position is anticipated to close on Jan 23, 2026. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.